Should Wayne County Count As Being Rural?

(Source: MIRS.news, Published 01/21/2026) Frustrations over how the Michigan Department of Health and Human Services (MDHHS) classifies “rural” dominated Tuesday's House Appropriations hearing, as Rep. Phil Green (R-Millington) and Rep. Cam Cavitt (R-Cheboygan) challenged the department on the criteria used to determine whether Michigan counties for sweeping new federal Rural Health Transformation dollars.

The exchange came as lawmakers reviewed Michigan's participation in a Centers for Medicare and Medicaid Services (CMS) Rural Health Transformation Program (RHTP), which gives states two years of planning support before a later implementation period. MDHHS is currently in the planning stage after responding to a CMS Notice of Funding Opportunity last fall.

Green signaled early skepticism about eligibility criteria and the metrics used by the Health Resources and Services Administration (HRSA) to determine rural status, asking whether “common sense” was applied referring to Wayne County being considered as rural. He warned that the current definitions used to determine rural status could undercut the program's value by not awarding money to the counties that need it most. Green also pointed to how Wayne County was awarded the same rural status as Lapeer County, and that St. Clair is not considered rural compared to Oakland County.

Cavitt echoed those concerns, sharing his worries about the rural northeast region he represents. Some counties, he said, have to drive an hour and a half to get to the emergency room. He added that some counties have no neonatal care and that he has the county with the highest poverty rate.

“But yet I see we're going to have to compete with partial counties such as Wayne,” Cavitt said.

Beth Nagel, MDHHS senior deputy director, emphasized that rural designations vary widely across federal agencies and said CMS did not impose a single definition, instead directing states to determine what qualifies as rural. Michigan's proposal relies on a healthcare-specific rural classification developed by the Federal Office of Rural Health within HRSA.

She also stated that the initiative is designed to guide long-term rural health planning, not provide immediate financial relief, with a two-year planning phase focused on identifying access gaps, workforce needs, and system inefficiencies before implementation funding is deployed.

Rep. Donavan McKinney (D-Detroit) pushed back on the criticism of Wayne County's inclusion, arguing that rural need exists even within Michigan's most populous county.

“We do have rural communities in Wayne County, contrary to popular belief,” he said, adding that parts of the west include farming communities and smaller townships that face many of the same access challenges. “Those areas need this program as much as other parts of our great state.”

McKinney said he took issue with what he described as lawmakers “harping on Wayne County,” and that this debate reflects broader concerns about healthcare access on the federal level. He said the transformation program is being used to offset federal policy changes that have strained healthcare access but replaces only a fraction of lost funding.

Still, Cavitt maintains that Wayne County should not be considered rural and that such status is “an insult to everyone living Up North.”